264673 Health system governance in the Arab world: A case study of six-countries

Tuesday, October 30, 2012 : 10:45 AM - 11:00 AM

Sameen Siddiqi, MD, MSc, DrMed, FFPH , Office of the Director, World Health Organization Country Office in Lebanon, Beirut, Lebanon
Samer Jabbour, MD, MPH , Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, PA, Lebanon
There is limited research on health system governance (HSG) in Arab countries. At a time of demands for more accountability and responsiveness to citizens' demands, HSG will become an increasingly important issue for governments and non-governments actors alike. We report the results of a regional study in six Arab countries (Egypt, Jordan, Lebanon, Syria, Sudan, and Tunisia) to assess HSG based on a novel analytic framework developed by the Eastern Mediterranean Regional Office of the World Health Organization. The framework poses questions for each of 10 principles strategic vision, consensus and participation, rule of law, transparency, responsiveness, equity and inclusiveness, efficiency and effectiveness, accountability, intelligence and information, and ethics at three levels: national, health policy formulation, and health policy implementation. Data were collected using mixed methods. Results, mapped to a matrix of the 10 principles across three levels, show some areas of strengths but important and pervasive deficiencies. Based on qualitative analysis, three key functions are prioritized: Strategic vision, transparency, and accountability. For example, there is incongruence of objectives between the strategic vision, operational plans, and the degree to which these get implemented; mechanisms to monitor transparency on the rationale of resource allocation are not well defined; and the culture of accountability to the public is not well entrenched. The country studies demonstrate these areas to be closely intertwined and influence health system performance. The recommendations for strengthening HSG concern building the evidence base on HSG, strengthening the role of the state and non-state actors, and tackling corruption.

Learning Areas:
Public health or related laws, regulations, standards, or guidelines
Public health or related organizational policy, standards, or other guidelines
Public health or related public policy
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
- Explain the importance of health system governance in public health - Compare the different frameworks in use to assess health system governance. - Describe the health system governance framework used in the current study. - Analyze the results of the six-country study. - Compare the findings across selected health system governance domains. - Discuss the implications of the study for reforms of health system governance in light of the transformative changes

Keywords: Public Policy, Government

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have developed the framework for health system governance and supervised a corresponding regional study. I have worked as the coordinator for health system development in the WHO Regional Office for the Eastern Mediterranean. In my current capacity as Head (Representative) of the World Health Organization Country Office in Lebanon I tackle the issue of health system governance regularly.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.